Chapter40-ElectricityELECTRICITY-PHYSIOLOGICALEFFECTSDominiqueFolliotThestudyofthehazards,electrophysiologyandpreventionofelectricalaccidentsrequiresanunderstandingofseveraltechnicalandmedicalconcepts.Thefollowingdefinitionsofelectrobiologicaltermsaretakenfromchapter891oftheInternationalElectrotechnicalVocabulary(Electrobiology)(InternationalElectrotechnicalCommission)(IEC)(1979).Anelectricalshockisthephysiopathologicaleffectresultingfromthedirectorindirectpassageofanexternalelectricalcurrentthroughthebody.Itincludesdirectandindirectcontactsandbothunipolarandbipolarcurrents.Individuals—livingordeceased—havingsufferedelectricalshocksaresaidtohavesufferedelectrification;thetermelectrocutionshouldbereservedforcasesinwhichdeathensues.Lightningstrikesarefatalelectricalshocksresultingfromlightning(Gourbiereetal.1994).InternationalstatisticsonelectricalaccidentshavebeencompiledbytheInternationalLabourOffice(ILO),theEuropeanUnion(EU),theUnioninternationaledesproducteursetdistributeursd’énergieélectrique(UNIPEDE),theInternationalSocialSecurityAssociation(ISSA)andtheTC64CommitteeoftheInternationalElectrotechnicalCommission.Interpretationofthesestatisticsishamperedbyvariationsindatacollectiontechniques,insurancepoliciesanddefinitionsoffatalaccidentsfromcountrytocountry.Nevertheless,thefollowingestimatesoftherateofelectrocutionarepossible(table40.1).Table40.1Estimatesoftherateofelectrocution-1988ElectrocutionspermillioninhabitantsTotaldeathsUnitedStates12.9714France2.0115Germany1.699Austria0.911Japan0.9112Sweden0.6131AccordingtotheNationalFireProtectionAssociation(Massachusetts,US)theseUSstatisticsaremorereflectiveofextensivedatacollectionandlegalreportingrequirementsthanofamoredangerousenvironment.USstatisticsincludedeathsfromexposuretopublicutilitytransmissionsystemsandelectrocutionscausedbyconsumerproducts.In1988,290deathswerecausedbyconsumerproducts(1.2deathspermillioninhabitants).In1993,therateofdeathbyelectrocutionfromallcausesdroppedto550(2.1deathspermillioninhabitants);38%wereconsumerproduct-related(0.8deathspermillioninhabitants).Thenumberofelectrocutionsisslowlydecreasing,bothinabsolutetermsand,evenmorestrikingly,asafunctionofthetotalconsumptionofelectricity.Approximatelyhalfofelectricalaccidentsareoccupationalinorigin,withtheotherhalfoccurringathomeandduringleisureactivities.InFrance,theaveragenumberoffatalitiesbetween1968and1991was151deathsperyear,accordingtotheInstitutnationaldelasantéetdelarecherchemédicale(INSERM).PhysicalandPhysiopathologicalBasisofElectrificationElectricalspecialistsdivideelectricalcontactsintotwogroups:directcontacts,involvingcontactwithlivecomponents,andindirectcontacts,involvinggroundedcontacts.Eachoftheserequiresfundamentallydifferentpreventivemeasures.Fromamedicalpointofview,thecurrent’spaththroughthebodyisthekeyprognosticandtherapeuticdeterminant.Forexample,bipolarcontactofachild’smouthwithanextensioncordplugcausesextremelyseriousburnstothemouth—butnotdeathifthechildiswellinsulatedfromtheground.Inoccupationalsettings,wherehighvoltagesarecommon,arcingbetweenanactivecomponentcarryingahighvoltageandworkerswhoapproachtoocloselyisalsopossible.Specificworksituationscanalsoaffecttheconsequencesofelectricalaccidents:forexample,workersmayfalloractinappropriatelywhensurprisedbyanotherwiserelativelyharmlesselectricalshock.Electricalaccidentsma...
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